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NICE bids to reduce antibiotic use for urinary tract infections

Primary care nurses are being urged to ask about the severity and regularity of urinary tract symptoms before they prescribe antibiotics, under latest draft guidance, which also advises against cranberry juice.

The National Institute of Health and Care Excellence has published a suite of new guidance on the treatment of urinary tract infections (UTIs) in a bid to encourage “smarter” use of antibiotics.

“Our new guidance will help healthcare professionals to optimise their use of antibiotics”

Mark Baker

The series of draft guidance documents, which are currently being consulted on, cover cystitis or lower UTIs, recurrent UTIs, acute pyelonephritis or kidney infection, and catheter-associated UTIs.

The guidelines come amid concern about the problem of antibiotic resistance in UTIs that is now common and getting worse, according to data from Public Health England.

NICE noted that, while antibiotics were often needed to treat UTIs, sometimes mild infections could get better without medication and could be treated via “self-care”.

It said nurses and other healthcare professionals should ask about the severity and regularity of symptoms before they prescribed antibiotics.

This should include asking patients about the steps they have already taken to manage their illness – such as taking painkillers – and may also include asking for a urine sample to test for infection.

“It is important that we treat these infections with an antibiotic that will work”

Tessa Lewis

The results can then be used to identify which antibiotic will work best, the guidance highlighted.

Professor Mark Baker, director for the centre of guidelines at NICE, said the majority of UTIs would require antibiotics but it was important to ensure treatment was appropriate in all cases.

“We recognise that the majority of UTIs will require antibiotic treatment, but we need to be smarter with our use of these medicines,” he said.

“Our new guidance will help healthcare professionals to optimise their use of antibiotics. This will help to protect these vital medicines and ensure that no one experiences side effects from a treatment they do not need.”

For example, the guidance suggests taking painkillers and plenty of fluids may be sufficient in some mild cases of cystitis and catheter-associated UTIs, while “advice about behavioural and personal hygiene measures” may help reduce the risk of recurrent infection.

However, it states that nurses, GPs and others should steer clear of recommending drinking cranberry juice – commonly believed to help alleviate symptoms – as there was no evidence this helped with conditions like cystitis.

Mark Baker

Mark Baker

In addition, the guidance looks at which antibiotics work best for different types of infection and advises on the length of a course of treatment.

For example, it notes that shorter courses of antibiotics often prove to be just as effective as a longer prescription, reducing the risk of unpleasant side effects like diarrhoea and nausea.

Regarding lower UTIs for women who are not pregnant, it said a three day course of antibiotics was as effective as a five to 10 day course for treating cystitis and resulted in fewer “adverse events”.

Meanwhile, the guidance stated that a three to seven day course of antibiotics could be as effective as a seven to 14 day course of medication for children and young people with lower UTI.

Dr Tessa Lewis, GP and chair of the managing common infections guidance committee, noted that UTIs were painful and distressing, so it was important to provide the right treatment.

“Urinary infections can make people feel very uncomfortable and unwell, and in some cases may become serious,” she said.

“It is important that we treat these infections with an antibiotic that will work,” she said. “This new draft guidance from NICE can assist healthcare professionals to do that.”

“This will preserve our antibiotics so they not only save lives today but can continue to save lives tomorrow”

Susan Hopkins

Monitoring by Public Health England shows a significant proportion of UTIs are now resistant to some of the most commonly-prescribed antibiotics.

Dr Susan Hopkins, deputy director for antibiotic microbial resistant and healthcare-associated infection at Public Health England, said: “Our surveillance shows that more than a third of laboratory confirmed E. coli UTIs display resistance to key antibiotics.

“We are, therefore, urging GP practices and hospitals to follow the new guidelines so they can prescribe antibiotics appropriately to their patients,” she said.

“This will preserve our antibiotics so that they not only save lives today but can continue to save lives tomorrow,” she added.

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